This inspection took place on 24 and 25 January and 2 February 2017. The first day of the inspection was unannounced. This meant that the registered provider and staff did not know we would be visiting. The other two days of inspection were announced.

The service was previously inspected in November 2015 and was not meeting one of the regulations we inspected. This related to people not being supported to maintain relationships or involvement in their community due to a lack of activities provision. We took action by requiring the registered provider to send us action plans telling us how they would improve this. When we returned for this inspection we found the issues identified had been addressed, though some improvement in activity provision was still required.

Ashwood Lodge is a 27 bedded care home providing residential care. The service does not provide nursing care. The home is a converted building, with all of the communal areas and bedrooms situated on the ground floor. At the time of the inspection 23 people were using the service, 14 of whom were living with dementia.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks to people were assessed and plans put in place to reduce the chances of them occurring. Regular checks of the service’s premises and equipment were carried out to ensure they were safe to use. Plans were in place to support people in emergency situations. The registered manager monitored accidents and incidents to see if lessons could be learned to help keep people safe.

People’s medicines were managed safely. Safeguarding procedures were in place to protect people from possible abuse. The registered manager monitored staffing levels to ensure enough staff were deployed to keep people safe. The registered provider’s recruitment process reduced the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively and were supported through regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to maintain a healthy diet and to access external professionals to maintain and promote their health.

People and their relatives spoke positively about the support they received from staff at the service, describing it as kind and caring. People were treated with dignity and respect. Staff encouraged people to be as independent as possible, while always ensuring they were available to provide support and keep people safe. Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services where these were needed.

We have made a recommendation about the planning and delivery of activities.

People’s care was based on their assessed needs and preferences. Care plans were regularly reviewed to ensure they reflected people’s current support needs. The service had a complaints policy, which was publicly advertised and accessible in the reception area. People and their relatives told us they knew how to complain and would be confident to do some.

Staff spoke positively about the culture and values of the service and said they felt supported by the registered manager and registered provider.

The registered manager carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people using the service and their families in an annual questionnaire. We received required notifications from the service.

A single inspector carried out this inspection. The focus of the inspection was to look at seven outcome areas and use our findings to consider five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Some part of the home needed maintenance work to ensure that they were safe and pleasant places for people to live. Some parts of the home were not clean and hygienic. For example, some carpets were badly marked, bathroom flooring was cracked and slippery when wet, some pieces of equipment and parts of the home were dirty and in need of cleaning. Compliance actions have been set and the provider must tell us how they plan to improve.

Medication systems were in place to help people get the medication they had been prescribed. Suitable arrangements were in place for the safe storage and administration of medication, with the manager able to demonstrate improvements that had recently been made. For example, increased stock checks and better recording.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One authorisation was in place at the time of our visit. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. Assessment and care planning systems were in place, to identify people’s needs and help staff provide the care people needed.

Quality assurance systems and checks were in place, but these had not always been effective at identifying and addressing problems at the service without external interventions. For example, the food hygiene issues recently raised by the Environmental Health Officer or the maintenance and cleanliness issues raised by our inspection.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were caring and supported people in kind and pleasant ways. People who used the service were complimentary about the attitude of the manager and staff, and care that they provided. One relative commented, “It may be a bit tired (the premises), but in what matters it’s amazing, in care, the way staff treat people”. Another relative told us, “They (the staff) are very good actually.”

Is the service responsive?

People’s needs had been assessed and care plans put in place describing their care needs. These records included information about people’s individual needs and preferences. There was evidence that people’s records had been reviewed and that other professionals were involved in people’s care appropriately. Where we have raised concerns the manager has listened and kept us informed of the actions they are taking.

Is the service well-led?

There was a registered manager in place, but they were often working as the senior carer on shift, rather than as a supernumerary manager. This had impacted on the time they had available to oversee the management and leadership of the service. Staff we spoke with indicated that the nominated individual (official company representative) did not visit the home very often and the records of the directors ‘monthly’ monitoring visits indicated that they had only completed three official monitoring visits in the last year. Concerns have recently been raised about the home's performance in some areas by the local authority, environmental health and ourselves. This indicated that the provider was not proactive in identifying and resolving issued independently.

One person told us, "The staff are good and I am well looked after." Another person told us, “I am very happy here, the staff can’t do enough for me.”

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We spoke to staff and found that they were very knowledgeable about people’s likes and dislikes and how they wished to be supported. We were able to see how people’s skills and independence were promoted.

Where people were highlighted as being at risk, for example, with pressure sores care plans had been developed. We found that care records contained up to date care plans and risk assessments.

We found that the care records contained evidence to confirm that people had been involved with health professionals. People's health, safety and welfare were protected when more than one provider was involved in their care and treatment.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because records were accurate and up to date.

Feedback from people who used the service, and their relatives, showed that they had been involved in discussions about their care and were happy with the service they received. Comments that were made to us included “they are all lovely”, “they are brilliant here, they really are good, sometimes they go beyond the call of duty” and “it’s a good care home I think”.

The care records we looked at, and our observations during this visit, showed that people’s needs were assessed and their care was planned and delivered appropriately. Staff were able to describe the care and support people needed and explain how they maintained people’s privacy and dignity.

Although the home is located in an old building, we found that it provided a safe and comfortable place for people to live. There had recently been some redecoration and new carpets installed. Staff told us that essential maintenance was carried out and people were not put at risk.

Feedback from people who used the service, and their relatives, indicated that staff were usually available when people needed them. Staff rotas, discussions with staff and our observations, showed that sufficient staff were on duty to meet the needs of the people living at the home.

People who use the service and their relatives told us that the manager was approachable and that they could speak to her if they wanted. There was a complaints procedure in place and records showed that complaints had been responded to appropriately.

A person we spoke with made positive comments about the staff who helped and supported them. They said, "The staff are very good, nothing is too much trouble." They said they were satisfied with everything at Ashwood Lodge and could not think of any improvements.

A relative we spoke with told us that they could not have asked for their relatives to have been better cared for. They said, "The staff have been marvellous, they are polite and respectful and so lovely."; "We have been kept well informed, if there are changes we are telephoned straight away." and "The manager is very helpful and supportive; they think of everything, they always have time to listen."

People spoken to said they thought there was sufficient staff available for them and thought their needs were being met. One person said, "The staff are really good, anything you want they get, there are enough staff and they are always there for you".

People spoken were satisfied with the care provided by the staff team. A relative said, "It is wonderful here, the staff are there all the time".

This inspection took place on 10 November 2015 and was unannounced. This meant that the provider did not know we would be visiting. A second day of inspection took place on 12 November 2015, and was announced. The service was previously inspected on 12 and 16 March 2015, and was not meeting six of the regulations we inspected.

Ashwood Lodge is a 27 bedded care home providing residential care. The service does not provide nursing care. The home is a converted building, with all of the communal areas and bedrooms situated on the ground floor. At the time of the inspection 20 people were using the service, 14 of whom were living with dementia.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a safeguarding policy in place that contained detailed guidance on possible types of abuse. Staff received training in safeguarding and felt confident in reporting issues should they arise.

Risks to people were assessed and minimised. Deficiencies in the premises had been remedied since our previous inspection though the building was in need of redecoration.

People were supported by staff who had been appropriately recruited and inducted.

The service had up-to-date policies and procedures in place to safely manage medicines and people had their own documents showing how their medicines should be used.

Staff received suitable training to ensure that they could appropriately support people. Some training was overdue but there was a plan in place to address this. Staff said they received sufficient training to do their jobs.

Staff understood and applied the principles of the Mental Capacity Act and the Deprivation of Liberty Standards to ensure that people received care that they consented to or was in their best interests.

People received suitable support with food and nutrition and were able to maintain a balanced diet. Mealtimes were enjoyable for people using the service.

The service worked with external professionals to support and maintain people’s health. The professionals we spoke with had no concerns about the service.

Staff treated people with dignity, respect and kindness and were knowledgeable about people’s needs, likes, interests and preferences. People had access to advocacy services.

Care records were detailed, personalised and focused on individual care needs. People’s preferences and needs were reflected in the support they received. External professionals thought that staff knew the people they were supporting well.

People did not have access to a wide range of activities, which meant that they sometimes felt socially isolated. This prevented them from maintaining relationships and links with their community.

The service had a clear complaints policy that was applied when issues arose.

The registered manager used audits to monitor and improve standards. The provider undertook site visits to review service quality.

Staff felt supported and included in the service by the registered manager. However, staff did not feel supported by the provider. The registered manager said they felt supported by the provider.